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State Center for Health Statistics Statistical Brief No. 28 – August 2005
1
Perinatal Periods of Risk ( PPOR): A Useful Tool for Analyzing Fetal and
Infant Mortality
by Manjoo Mittal
Statistical Brief No. 28
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics August 2005
Statistical
Brief
www. schs. state. nc. us/ SCHS/
Introduction
Perinatal Periods of Risk ( PPOR) analysis is an
approach to investigating and monitoring causes of
fetal and infant deaths. This conceptual tool, devel-oped
by Dr. Brian McCarthy at the Centers for
Disease Control and Prevention ( CDC), provides a
framework for mapping fetal- infant mortality by
birth weight and age at death.
Fetal deaths are stillbirths and infant deaths are
deaths less than one year of age to babies born alive.
The PPOR methodology includes only fetal deaths
of 24 or more weeks gestation. Most states receive
reports of fetal deaths only if they are 20 or more
weeks gestation.
PPOR analysis is often carried out for a specific
county or other local geographic area. Data on fetal
and infant deaths can be used to mobilize communi-ties
by identifying areas to be targeted for investiga-tion.
By investigating the mortality numbers in
detail, areas for further analysis can be identified.
Given limited resources, this process can also help
in prioritizing strategies for prevention efforts.
Improving fetal- infant mortality rates requires the
involvement and mobilization of many sectors in the
community. When the various partners have been
involved at an early stage, they have more owner-ship
and stake in the process. This also leads to the
development of better understanding of the problem
and can lead to successful consensus- building
regarding possible solutions.
The purpose of this paper is to introduce health
professionals in North Carolina to the PPOR
methodology and to stimulate interest in the exami-nation
of additional regional and local data. We
looked at statewide data for a three- year period,
2000- 2002.
Results
Table 1 maps fetal- infant mortality by birth weight
and age at death for 2000- 2002. The overall infant
mortality rate was 9.9 per 1,000 fetal deaths and live
births. There are four major components that
comprise this rate, namely deaths related to Mater-nal
Health and Prematurity, Maternal Care, New-born
Care, and Infant Care. These components
define broad areas where interventions to reduce
fetal- infant mortality might be targeted. These
components take into account both the time of death
and weight at delivery.
Fetal deaths that are for 24 weeks or greater gesta-tion
and weighing 500- 1,499 grams, along with the
neonatal and postneonatal deaths that weigh 500-
1,499 grams at delivery, constitute the Maternal
Health and Prematurity subgroup. Neonatal deaths
are infant deaths occurring at less than 28 days of
age, and postneonatal deaths are infant deaths at 28-
364 days of age. The fetal deaths with gestational
age of 24 weeks or more and delivery weight more
than 1,500 grams make up the Maternal Care

State Center for Health Statistics Statistical Brief No. 28 – August 2005
1
Perinatal Periods of Risk ( PPOR): A Useful Tool for Analyzing Fetal and
Infant Mortality
by Manjoo Mittal
Statistical Brief No. 28
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics August 2005
Statistical
Brief
www. schs. state. nc. us/ SCHS/
Introduction
Perinatal Periods of Risk ( PPOR) analysis is an
approach to investigating and monitoring causes of
fetal and infant deaths. This conceptual tool, devel-oped
by Dr. Brian McCarthy at the Centers for
Disease Control and Prevention ( CDC), provides a
framework for mapping fetal- infant mortality by
birth weight and age at death.
Fetal deaths are stillbirths and infant deaths are
deaths less than one year of age to babies born alive.
The PPOR methodology includes only fetal deaths
of 24 or more weeks gestation. Most states receive
reports of fetal deaths only if they are 20 or more
weeks gestation.
PPOR analysis is often carried out for a specific
county or other local geographic area. Data on fetal
and infant deaths can be used to mobilize communi-ties
by identifying areas to be targeted for investiga-tion.
By investigating the mortality numbers in
detail, areas for further analysis can be identified.
Given limited resources, this process can also help
in prioritizing strategies for prevention efforts.
Improving fetal- infant mortality rates requires the
involvement and mobilization of many sectors in the
community. When the various partners have been
involved at an early stage, they have more owner-ship
and stake in the process. This also leads to the
development of better understanding of the problem
and can lead to successful consensus- building
regarding possible solutions.
The purpose of this paper is to introduce health
professionals in North Carolina to the PPOR
methodology and to stimulate interest in the exami-nation
of additional regional and local data. We
looked at statewide data for a three- year period,
2000- 2002.
Results
Table 1 maps fetal- infant mortality by birth weight
and age at death for 2000- 2002. The overall infant
mortality rate was 9.9 per 1,000 fetal deaths and live
births. There are four major components that
comprise this rate, namely deaths related to Mater-nal
Health and Prematurity, Maternal Care, New-born
Care, and Infant Care. These components
define broad areas where interventions to reduce
fetal- infant mortality might be targeted. These
components take into account both the time of death
and weight at delivery.
Fetal deaths that are for 24 weeks or greater gesta-tion
and weighing 500- 1,499 grams, along with the
neonatal and postneonatal deaths that weigh 500-
1,499 grams at delivery, constitute the Maternal
Health and Prematurity subgroup. Neonatal deaths
are infant deaths occurring at less than 28 days of
age, and postneonatal deaths are infant deaths at 28-
364 days of age. The fetal deaths with gestational
age of 24 weeks or more and delivery weight more
than 1,500 grams make up the Maternal Care